Jean Toupin

Cognitive and familial contributions to conduct disorder in children.

Although young children with conduct disorder (CD) are suspected of having verbal and executive function deficits, most studies that investigated this hypothesis did not control for attention deficit hyperactivity disorder (ADHD). Furthermore, relatively little is known about the interaction between cognitive deficits and familial factors in explaining the onset and persistence of CD in children. The participants in this study were 57 children with CD and 35 controls aged 7 to 12 years. At 1-year follow-up, 41 of the participants with CD were reassessed. Children with CD were found to be significantly impaired in four of five executive function measures after ADHD symptoms and socioeconomic status (SES) were controlled. Executive function test performance, number of ADHD symptoms, and familial characteristics (SES, parental punishment) together correctly classified 90% of the participants. Only the number of ADHD symptoms was found to significantly improve prediction of CD 1 year later beyond that afforded by number of CD symptoms a year earlier. Findings indicate that children with CD and ADHD symptoms are especially at risk for persistent antisocial behaviour. Results also highlight the importance of treatment programs that cover both cognitive and familial aspects associated with CD.

Factors related to utilization of services for mental health reasons in Montreal, Canada.

Abstract This study examines factors related to the utilization of services for mental health reasons by Montreal residents. Data were drawn from telephone interviews. A random sample of 893 respondents completed a questionnaire on service utilization and the Diagnostic Interview Schedule Self Administered to assess DSM-III-R psychiatric disorders. Results indicate that 12.8% of the population had used such services in the past year. Medical doctors and psychiatrists, whose services are free of charge under universal health coverage, were consulted, respectively, by 4.1% and 2.0% of respondents. Psychologists, whose services are not free, were seen by 3.4% of respondents. In all, 42.0% of respondents who presented a current diagnosis used services in the past year. The highest proportion of users (48.0%) was found among respondents who presented both current and lifetime diagnoses and among respondents with comorbidity. The choice of caregiver was related also to pattern of disorders: respondents with current and comorbid disorders tended to consult general practitioners, while respondents with lifetime disorders or with lifetime and current disorders favoured specialized care. In line with other studies, self-perception of mental health, gender and marital status were related to utilization; unlike other studies, attitudes and age were not. It is argued that particularities found in this study stem not only from methodological considerations, but also from the configuration of the mental health system in Quebec, where the greater availability of psychologists may facilitate service utilization.

Behavioral inhibition deficits in juvenile psychopaths

Although many studies have shown that delinquents are impaired on certain executive function tasks related to frontal lobe functioning, whether psychopaths present with such impairments is still controversial. Lapierre et al. [1995. Neuropsychologia 33:139–151] have investigated a more specific hypothesis of orbitofrontal deficits in psychopaths and found that psychopathic criminals are impaired on tasks involving behavioral inhibition and olfactory discrimination. The present study sought to replicate these results with juvenile psychopaths 14 to 18 years of age. As expected, psychopaths were found to be significantly impaired on behavioral inhibition tasks. However, psychopathic and nonpsychopathic inmates performed similarly on measures related to the dorsolateral area of the frontal lobe. Also, no significant intergroup difference was noted on the olfactory discrimination task. Although an orbitofrontal deficit in psychopathy remains possible, it is suggested to explain results through a functional inhibition deficit that is not specifically related to orbitofrontal processing. Aggr. Behav. 26:413–424, 2000.

Neuropsychological characteristics of adolescents with conduct disorder: association with attention-deficit-hyperactivity and aggression.

The purpose of this study was to determine whether an association exists between neuropsychological deficits and conduct disorder (CD) with and without concurrent attention-deficit–hyperactivity disorder (ADHD). In addition, we explored the differential neuropsychological performance of aggressive and nonaggressive CD adolescents and the combined effect of this behavioral status and ADHD on performance. Fifty-nine adolescents (mean age of 15.4 years) who met the criteria for CD were compared with 29 controls comparable in age, gender, and socioeconomic status. A neuropsychological battery of current tests measuring executive functions and a battery of language tests were used in the study. Multivariate analyses showed that, compared with controls, CD adolescents had significantly lower verbal skills but did not differ on executive function measures. However, the lower verbal performance of CD adolescents is not explained by the existence of a CD subgroup with concomitant ADHD or aggressiveness. The study confirms with a sample of CD adolescents the association between verbal deficits and antisocial behavior when socioeconomic status is controlled. Our results also demonstrate that CD per se can be a sufficient condition for such deficits.

Criminal activities and substance use of patients with major affective disorders and schizophrenia: a 2-year follow-up.

BACKGROUND Compelling findings demonstrate that persons who develop major mental disorders, as compared to those who do not, are at increased risk to commit non-violent and violent crimes. This conclusion has recently been shown to apply to persons with major affective disorders. METHODS Thirty males with major affective disorders and 74 with schizophrenia were followed for 2 years. At discharge, patients were intensively assessed including diagnoses using SADs and RDC. During follow-up, alcohol and drug use were measured, subjectively and objectively. At discharge, the two groups were similar as to secondary diagnoses of antisocial personality disorder, drug abuse/dependence, socio-demographic characteristics, and criminal history, but more of the patients with major affective disorders than those with schizophrenia had a history of alcohol abuse/dependence. During the follow-up period, the two groups were similar as to rehospitalization, treatment intensity, and substance use. RESULTS By the end of the follow-up period, 33% of the patients with major affective disorders and only 15% of those with schizophrenia had committed crimes, most violent. Co-morbid antisocial personality disorder was associated with criminality among the patients with schizophrenia but not among those with major affective disorders. Among these latter patients, drug use and the intensity of out-patient care were associated with violent criminality. LIMITATIONS The small number of subjects limited the conclusions. CONCLUSIONS Violent behavior among patients with major affective disorders may not be uncommon and may be preventable by out-patient treatment which limits drug use.

Frequency of Mental Health Disorders in a Sample of Elementary School Students Receiving Special Educational Services for Behavioural Difficulties

Objective: Despite being essential for defining and planning special educational services, very few data are available in Quebec regarding the nature and extent of behavioural difficulties presented by children who receive special educational services at school. This study provides a picture of the frequency of disruptive behaviour disorders (that is, attention-deficit hyperactivity disorder [ADHD], oppositional defiant disorder [ODD], and conduct disorder [CD]) and internalized disorders (including generalized anxiety disorder [GAD] and major depressive episode [MDE]) in a sample of elementary school students receiving special educational services for behavioural difficulties (n = 324). Method: In this descriptive study, we established the presence of mental health disorders according to teacher-, parent-, and child-reported data that were obtained using structured diagnostic interviews based on DSM-IV criteria. We also examined prevalence rates by sex and age group. Results: Three-quarters of the students met the criteria for ADHD, one-half for ODD, and one-third for CD. About 14% of the students presented with a GAD or met the criteria for an MDE in the past year. Only 2% of the students presented with an internalized disorder without a comorbid disruptive behaviour disorder. Conclusions: Our results suggest that among students receiving special educational services for behavioural difficulties, a large proportion may have difficulties severe enough to meet the criteria for at least one DSM-IV disruptive behaviour disorder. Such findings may underscore the need to develop more collaboration between the mental health and education sectors in rehabilitating these children.

Telephone surveys as an alternative for estimating prevalence of mental disorders and service utilization: a Montreal catchment area study.

Background: Large-scale mental health surveys have provided invaluable information regarding the prevalence of specific mental disorders and service use for mental health reasons. Unfortunately, because vast surveys conducted face to face are very costly, many countries and provinces do not embark upon this path of research, thus depriving themselves of a rich source of data useful for service planning. Method: As an alternative, the authors undertook a telephone survey with a sample of 893 residents from a Montreal catchment area. Mental disorders were assessed by the Composite International Diagnostic Interview Simplified (CIDIS), an instrument especially designed to be used in mail or telephone surveys. Service utilization was measured by an instrument similar to those used in recent large Canadian or American surveys. Results: The prevalence rate for any mental disorder was lower in this study than in some large-scale epidemiological surveys reviewed. This could be explained by methodological differences, such as number of disorders covered and period of reference. With regard to specific mental disorders, results appeared very similar to those of other studies. Concerning service utilization, rates tended to be higher than in other studies, and this finding could reflect real differences between Quebec and other Canadian provinces or the United States. Conclusions: Aside from being lower in cost, telephone surveys can yield results comparable to those obtained in large-scale epidemiological surveys conducted by means of face-to-face interviews.

Rate and characteristics of men with an intellectual disability in pre‐trial detention

Abstract Background Various lines of research point to the overrepresentation of individuals with intellectual disability1 (ID) in the criminal justice system. Studies have also shown that individuals with ID are vulnerable to mental health problems. To date there have been no Canadian studies of individuals with an ID in the criminal justice system. Method The present study reports on the sociodemographic, mental health and criminological characteristics of 281 individuals with an ID from a Canadian study of men in a pre‐trial holding centre. Results Almost 19% of the men had a probable ID, and nearly one‐third (29.9%) were in the borderline IQ range. As was the case for their non‐ID counterparts, the mean age of the probable ID group was in the early 30s, few were employed, and most had low incomes. Individuals in the probable and borderline ID groups had lower rates of high school completion than those in the average intellectual ability range. Over 60% of individuals with an ID had a substance use disorder, and 1 in 5 was intoxicated at the time of assessment. These rates were similar across groups, and to those found in the literature. A large majority of individuals with ID had a previous conviction, and most had previously committed a violent offence. Conclusions Among other limitations, the sample may not have been entirely representative of the total population of men in the pre‐trial detention centre, given the relatively high refusal rate (39.5%). Results are discussed in terms of orienting criminological and mental health services as a function of the level of intellectual and adaptive functioning of individuals with ID.

Predictors of Maternal Support: The Point of View of Adolescent Victims of Sexual Abuse and Their Mothers.

ABSTRACT Maternal support received by sexual abuse victims is considered a key factor in coping with the aftermath of abuse. The present study looked at four groups of potential predictors of maternal support: mothers psychosocial characteristics, abuse characteristics, victims characteristics, and disclosure characteristics. A total of 120 adolescents aged 12 to 17 years and their mothers, who were recruited from Child Protective Services, completed questionnaires and semi-structured interviews. Multiple regression analyses performed separately on mother and child data sets revealed five significant predictors of maternal support in each analysis, four of which were common to both. The discussion underscores the importance of taking into account both the mothers and the victims perceptions regarding psychological adjustment and family environment.

Major Mental Disorder and Crime: An Etiological Hypothesis

Evidence has been accumulating since the 1960’s indicating that greater proportions of persons who suffer from major mental disorders than non-disordered persons commit crimes, commit crimes of violence, and behave aggressively towards others. Three types of investigations have addressed the relation between the major mental disorders and crime: follow-up studies of psychiatric patients discharged to the community; studies of the prevalence of the major mental disorders among convicted offenders; and investigations of unselected birth cohorts comparing the prevalence of criminality among persons with major disorders and with no disorders. A fourth type of investigation has examined aggressive behavior.